Provider Demographics
NPI:1902826464
Name:POUYA MOHAJER MD LTD
Entity Type:Organization
Organization Name:POUYA MOHAJER MD LTD
Other - Org Name:PRIMMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:POUYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAJER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-798-0111
Mailing Address - Street 1:5741 S FORT APACHE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5622
Mailing Address - Country:US
Mailing Address - Phone:702-798-0111
Mailing Address - Fax:844-247-3481
Practice Address - Street 1:5741 S FORT APACHE RD STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148
Practice Address - Country:US
Practice Address - Phone:702-798-0111
Practice Address - Fax:866-333-0436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510908Medicaid
NV100510908Medicaid
NVI18257Medicare UPIN